LONG ISLAND SUMMER SHOWCASE CAMP
EXPLORE MORE AT
SURGEELITELAX.COM
MAIL TO:
128 POINTE CIRCLE SOUTH
CORAM, NY 11727
KARA MUPO
AND
PRESENT
JULY 30TH
OPEN TO ANY AND ALL HIGH SCHOOL GIRLS GRADUATING IN 2018-2020
9AM-12PM 1PM-4PMBLUE (2020) VOLT (2018/2019)
FEATURING COACHES FROM: ARMY, COLUMBIA, MARQUETTE, MOUNT ST. MARY'S, OHIO STATE, STONY BROOK, UMASS, VANDERBILT, WAGNER AND WILLIAM & MARY
VENUE DETAILS:ST. JOSEPH'S COLLEGE
246 Service RoadPatchogue, NY 11772
2X NATIONAL
CHAMPION & CURRENT
TEAM USA MEMBER
SESSION: (CIRCLE ONE)
$155.00
NAME:
EMAIL:
EMERGENCY CONTACT:SURGE ELITE LACROSSE ACADEMY
EMERGENCY CONTACT PHONE:LIABILITY RELEASE: IN CONSIDERATION OF MY ATTENDANCE, I, THE UNDERSIGNED PARTICIPANT INTENDING TO BE LEGALLY BOUND, DO HEREBY FOR MYSELF, MY HEIRS, EXECUTORS AND ADMINISTRATORS , WAIVE, RELEASE AND FOREVER DISCHARGE ANY AND ALL RIGHTS AND DAMAGES WHICH I OR ANY OF US MAY HEREAFTER HAVE AGAINST SURGE ELITE LACROSSE ACADEMY , ST. JOSEPH'S COLLEGE OR ITS RESPECTIVE OFFICERS, AGENTS, REPRESENTATIVES, SUPPLIERS/VENDORS AND/OR ASSIGNED FOR ANY DAMAGES WHICH MAY BE SUSTAINED OR SUFFERED BY ME IN CONNECTION WITH OR ENTRY IN AND/OR ARISING OUT OF MY TRAVEL TO PARTICIPATE AND RETURN FROM THE FACILITY.
OR SUBMIT TO:
PARENT SIGNATURE:
PAYMENT DETAILS:BALANCE DUE APRIL 30TH